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Because type 2 diabetes is linked to high levels of sugar in the blood, it may seem logical to assume that eating too much sugar is the cause of the disease. But of course, it’s not that simple.

Studies do show that sweetened foods can up type 2 diabetes risk, but sugar alone isn’t necessarily enough to cause the disease on its own. With more than 29 million Americans living with diabetes and millions more at high risk for the disease, understanding risk factors — like how sugar affects diabetes — is essential to reverse the diabetes epidemic.

The Sugar and Type 2 Diabetes Story: Not So Sweet

The sugars in food are known as simple carbohydrates and are natural components of many fresh foods, such as the lactose in milk and the fructose in fruits. A healthy, well-balanced diet will always contain these natural sugars.

But the problem with sugar is the sheer amount of it that’s found in the typical American diet, especially in the form of added sugars: the sucrose in table sugar, as well as sugars in foods such as sodas, cereals, packaged foods, and snacks. When consumed in excess, added sugars can cause weight gain, heart disease, mood swings, and more.

One particular type of sugar that has attracted a lot of negative attention is high-fructose corn syrup. Because it’s a relatively cheap ingredient, high fructose corn syrup has become the most commonly used sweetener in processed foods. Like table sugar, it causes blood sugar spikes and may contribute to weight gain.

Although high fructose corn syrup has been vilified for decades, researchers are now finding that added sweeteners of all kinds affect the body similarly — and all are bad. In a study published in April 2009 in The Journal of Clinical Investigation, scientists found that consuming three sweetened drinks a day for 10 weeks resulted in a nearly 4-pound weight gain and added nearly an extra inch to the waistline, regardless of whether the sweetener was fructose or glucose. Even worse, consuming these sweeteners — fructose in particular — led to decreased insulin sensitivity and higher blood sugar levels, the hallmark predictors of diabetes.

It's Not Just Sugar: Other Diabetes Risk Factors to Consider

Although this research may prompt you to ditch the soda and avoid sweets, remember that consumption of too much fat can have the same effect as sugar on your diabetes risk. Obesity, being overweight, and a family history of diabetes are other important predictors for the disease. People who exercise fewer than three times a week, and women who've been diagnosed with gestational diabetes or diabetes that develops while a woman is pregnant, also have an increased chance of a type 2 diabetes diagnosis.

Certain ethnic groups, including American Indians, African-Americans, Asian-Americans, and Hispanics, are more likely to get diabetes than Caucasians — a phenomenon researchers currently attribute to both lifestyle factors and genetics.

While assessing your risk, keep in mind that not every case of diabetes is from diet. Type 1 diabetes occurs when, for unknown reasons, the body’s immune system attacks its own pancreas — usually at a young age — hurting the organ’s ability to produce insulin. The end result is similar to type 2 diabetes, with blood sugar levels staying high if you don’t get the necessary treatment.

In type 2 diabetes, the cells in the body do not respond well to insulin, a hormone responsible for bringing glucose into cells to be used as energy and, therefore, keeping blood sugars low. When this doesn’t happen properly, blood sugar levels remain higher than normal. Many people with diabetes take drugs like metformin to help keep their blood sugar in check.

The bottom line? You don’t have to avoid any food group entirely to prevent diabetes, but monitoring your intake of sugar and sugar substitutes is essential for managing your risk and your overall health.

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